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Bruises and Blood Spots Under the Skin

Topic Overview

Bruises

Bruises develop when small blood vessels
under the skin tear or rupture, most often from a bump or fall. Blood leaks
into tissues under the skin and causes the black-and-blue color. As
bruises (contusions) heal, usually within 2 to 4 weeks, they often turn colors,
including purplish black, reddish blue, or yellowish green. Sometimes the area
of the bruise spreads down the body in the direction of gravity. A bruise on a
leg usually will take longer to heal than a bruise on the face or arms.

Most bruises are not a cause for concern and will go away on their own.
Home treatment may speed healing and relieve the swelling and soreness that
often accompany bruises that are caused by injury. But severe bruising,
swelling, and pain that begin within 30 minutes of an injury may mean a more
serious problem, such as a severe
sprain or
fracture.

If you bruise easily, you may
not even remember what caused a bruise. Bruising easily does not mean you have
a serious health problem, especially if bruising is minimal or only shows up
once in a while.

Older adults often bruise easily from minor
injuries, especially injuries to the forearms, hands, legs, and feet. As a
person ages, the skin becomes less flexible and thinner because there is less
fat under the skin. The cushioning effect of the skin decreases as the fat
under the skin decreases. These changes, along with skin damage from exposure
to the sun, cause blood vessels to break easily. When blood vessels break,
bruising occurs.

Women bruise more easily than men, especially from
minor injuries on the thighs, buttocks, and upper arms.

A tendency
to bruise easily sometimes runs in families.

Occasionally after an injury, blood collects and pools under
the skin (hematoma), giving the skin a spongy, rubbery, lumpy feel. A regular
bruise is more spread out and may not feel like a firm lump. A hematoma usually
is not a cause for concern. It is not the same thing as a
blood clot in a vein, and it does not cause blood
clots.

Bruises that do not appear to be caused by an accidental
injury may be caused by
abuse. It is important to consider this possibility,
especially if the bruises can't be explained or if the explanations change or
do not match the injury. Report this type of bruising and seek help to prevent
further abuse.

Blood spots

Blood spots under the skin may be either
purpura or
petechiae. Purpura might look like bruises, but they
are not caused by an injury as most regular bruises are. Petechiae don't look
like bruises. They are tiny, flat, red or purple spots in the skin, but they
are different than the tiny, flat, red spots or birthmarks (hemangiomas) that
are present all the time.

Sudden unexplained bruising or blood spots under the skin
or a sudden increase in the frequency of bruising may be caused by:

Malnutrition, such as
deficiencies of vitamins
B12, C, or K, or
folic acid.

Medical treatment for abnormal bruising or blood spots focuses
on preventing or stopping bleeding, changing or adjusting a medicine that may
be causing the bruising, or treating the medical problem that is causing the
bruising.

If the skin is injured over a bruise, be sure to watch
for signs of a
skin infection.

Check Your Symptoms

Do you have bruises or blood spots under the skin?

If a bruise is rapidly spreading, you need try to stop the bleeding under the skin. Wrap the area (not too tightly) with an elastic bandage, such as an Ace wrap, and keep it on until you see a doctor. You can also put direct pressure on the area for 15 minutes at a time.

Home Treatment

If your bruise does not require an
evaluation by a doctor, you may be able to use home treatment to
help relieve pain, swelling, and stiffness.

Rest and protect a bruised
area.

Ice will reduce pain and swelling.
Apply ice or cold packs immediately to prevent or minimize swelling. Apply the
ice or cold pack for 10 to 20 minutes, 3 or more times a day.

For the first 48 hours after an injury, avoid
things that might increase swelling, such as hot showers, hot tubs, hot packs,
or alcoholic beverages.

After 48 to 72 hours, if swelling is gone,
apply heat and begin gentle exercise with the aid of moist heat to help restore
and maintain flexibility. Some experts recommend alternating between hot and
cold treatments.

Compression, or wrapping the
bruised area with an elastic bandage (such as an Ace wrap), will help decrease
swelling. Don't wrap it too tightly, as this can cause more swelling below the
affected area. Loosen the bandage if it gets too tight. Signs that the bandage
is too tight include numbness, tingling, increased pain, coolness, or swelling
in the area below the bandage. Talk to your doctor if you think
you need to use a wrap for longer than 48 to 72 hours. A more serious problem
may be present.

Elevate the bruised area on
pillows while applying ice and anytime you are sitting or lying down. Try to
keep the area at or above the level of your heart to help minimize swelling.

Gently massage or rub the area to relieve pain and encourage blood
flow. Do not massage the bruised area if it causes pain.

If your bruise is causing pain, take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Read and follow all instructions on the label.

Symptoms to watch for during home treatment

Prevention

You can't always prevent
bruises, but most of the time bruises are not a cause
for concern.

If you take aspirin,
other
nonsteroidal anti-inflammatory drugs (NSAIDs), or
blood-thinning medicines (anticoagulants), keep regular
appointments with your doctor so that he or she can monitor your
medicine dosages and make any necessary changes or adjustments.

Eat
a variety of foods to avoid dietary deficiencies. Nutritional deficiencies of
vitamins C, K, or B12, or
folic acid can affect blood clotting. Include a daily
selection of:

Whole-grain and enriched breads, cereals, and
grain products.

Vegetables.

Fruits.

Milk,
cheese, and yogurt.

Meats, poultry, fish, eggs, dried beans and
peas, and tofu.

Do not take dietary supplements that may increase
bruising, particularly if you take a blood-thinning medicine. Dietary
supplements that may increase bruising include fish oil, vitamin E, garlic,
ginger, and ginkgo biloba.

Bruises are often the first sign of
abuse. You may be able to prevent further abuse by
reporting it and seeking help.

Call your local child or adult protective agency,
police, or clergy or a health professional (such as a doctor, nurse, or
counselor) if you suspect abuse.

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